This report provides the first-ever comparative analysis of the role and performance of private health insurance (PHI) in OECD countries. It analyses PHI markets and identifies policy issues arising from their interdependence with publicly financed health coverage schemes. The report assesses the impact of PHI against health policy objectives, paying special attention to the challenges and benefits associated with different insurance mixes. The analysis identifies strengths as well as areas where private health insurance might pose challenges to health system performance. This report shows how governments can help ensure that PHI markets make a positive contribution to the performance of health systems. Examples of useful practices for developing more efficient and equitable health insurance markets are also presented.